Market Conduct PBM Examiner

State of Vermont; Montpelier (VT); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental plan

Paid holidays

Pension plan

Tuition reimbursement

Flexible spending accounts

Job summary

The Vermont Department of Financial Regulation seeks a Market Conduct PBM Examiner to oversee the regulatory oversight of PBMs operating in Vermont. The role includes conducting examinations, reviewing contracts, and analyzing claims data to ensure compliance with state laws and regulations.

Ideal candidates will have PBM experience, strong communication skills, and the ability to interpret laws, with readiness for potentially adversarial discussions and complex negotiations.

Qualifications

• Four (4) years of experience in insurance regulation, market conduct examination, Pharmacy Benefit Management compliance, healthcare policy analysis, or a related field, including two (2) years at a supervisory or lead examiner level.
• OR two (2) years or more as a Market Conduct Examiner with a focus on health insurance or PBM-related matters.

Responsibilities

• Examine and investigate PBMs and third-party administrators to assess compliance with Vermont laws and regulations.
• Review PBM contracts with health plans and pharmacies and analyze pharmacy claims data.
• Write comprehensive reports on findings and work with entities on compliance plans.

Skills

PBM regulations

Communication

Legal interpretation

Negotiation

Regulatory analysis

Job description

Overview

The Vermont Department of Financial Regulation is seeking a Market Conduct PBM Examiner to monitor and regulate Pharmacy Benefit Managers (PBMs) operating in Vermont. This is an opportunity to take a leading role in the Vermont's newly regulated PBM market. This position conducts examinations and investigations of PBMs and third-party administrators (TPAs) to assess compliance with Vermont laws and regulations.

The work involves reviewing PBM contracts with health plans and pharmacies, analyzing pharmacy claims data, writing comprehensive reports on findings, and working with entities on compliance plans. The ideal candidate will have experience with PBM operations and/or pharmacy claims, strong communication skills, experience interpreting laws and regulations, and be comfortable in potentially adversarial situations.

If you are motivated by helping others and believe in public service, this is an opportunity to join a team dedicated to serving Vermonters.

Who May Apply

This position, Market Conduct PBM Examiner (Job Requisition #54956), is open to all State employees and external applicants.

If you would like more information about this position, please contact [e-mail]

Please note that multiple positions in the same work location may be filled from this job posting.

Environmental Factors

Duties are performed primarily in an office setting with the possibility of remote work. Occasional in-state and out-of-state travel may be required for examinations, training, or industry meetings. The role may involve working outside of normal business hours to meet regulatory deadlines. The position requires engagement with PBM representatives, insurers, legal professionals, and policymakers, which may lead to complex negotiations and high-pressure discussions.

Minimum Qualifications

Four (4) years of experience in insurance regulation, market conduct examination, Pharmacy Benefit Management compliance, healthcare policy analysis, or a related field, including two (2) years at a supervisory or lead examiner level.

OR

Two (2) years or more as a Market Conduct Examiner with a focus on health insurance or PBM-related matters.

Preferred Qualifications

• Associate Professional in Insurance Regulation (APIR)
• Professional in Insurance Regulation (PIR)
• Market Conduct Manager (MCM)
• Accredited Insurance Examiner (AIE)
• Certified Insurance Examiner (CIE)
• Any designation specific to health insurance or PBMs

Total Compensation

As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits, including:

• 80% State paid medical premium and a dental plan at no cost for employees and their families
• Work/Life balance: 11 paid holidays each year and a generous leave plan
• State Paid Family and Medical Leave Insurance (FMLI)
• Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
• Tuition Reimbursement
• Flexible spending healthcare and childcare reimbursement accounts
• Low cost group life insurance
• Incentive-based Wellness Program
• Qualified Employer for Public Service Student Loan Forgiveness Program

Equal Opportunity Employer

The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State's employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.